WPDL and EA List updates - Methadone prior authorization

HCA Apple Health

Provider Alert

Dear Provider:

Effective for dates of service on and after September 1, 2015, Washington Apple Health (Medicaid), administered by the Health Care Authority, will require prior authorization for methadone.  

The agency is changing the authorization status for methadone as directed by the Washington Medicaid Drug Utilization Review board due to concern over the high number of methadone related fatalities in the State of Washington. The agency will require authorization for new starts for methadone when medically necessary, as evidenced by intolerance to or failure of all generic long-acting opioids to treat the client’s pain.   

The agency will allow clients currently receiving methadone to continue receiving methadone without authorization or restriction when the agency has record of payment for methadone in the last two months.  

The agency will also continue to cover methadone without restriction for clients actively being treated for cancer pain, using expedited authorization (EA) code 85000000040.  

For clients new to Washington Apple Health for whom the agency does not have current record of payment for methadone, but who have been actively taking methadone paid for out-of-pocket or by another payer, pharmacies may request authorization by calling toll-free 866-668-1214 and indicating that the methadone is a continuation of current treatment for the client.  

For more information, see the agency’s Washington Preferred Drug List (WPDL) and Expedited Authorization List (EA)